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  1. Article ; Online: Experience matters for robotic assistance: an analysis of case data.

    Brian, Riley / Oh, Daniel / Ifuku, Kelli Ann / Sarin, Ankit / O'Sullivan, Patricia / Chern, Hueylan

    Journal of robotic surgery

    2023  Volume 17, Issue 5, Page(s) 2421–2426

    Abstract: Many robotic procedures require active participation by assistants. Most prior work on assistants' effect on outcomes has been limited in procedural focus and scope, with studies reporting differing results. Knowing how assistant experience affects ... ...

    Abstract Many robotic procedures require active participation by assistants. Most prior work on assistants' effect on outcomes has been limited in procedural focus and scope, with studies reporting differing results. Knowing how assistant experience affects operating room time could inform operating room case scheduling and provide an impetus for additional assistant training. As such, this retrospective cohort study aimed to determine the association between assistant experience and operating room time for 2291 robotic-assisted operations performed from 2016 to 2022 at our institution. Linear regression showed a significant association between the presence of a junior resident and increased case length differential with an increase of 26.9 min (p = 0.01). There were no significant associations between the presence of a senior resident (p = 0.52), presence of a fellow (p = 0.20), or presence of a physician assistant (p = 0.43) and case length differential. The finding of increased operating room time in the presence of a junior resident during robotic cases supports consideration of the adoption of formal assistant training programs for residents to improve efficiency.
    MeSH term(s) Humans ; Robotic Surgical Procedures/methods ; Internship and Residency ; Retrospective Studies ; Robotics/education ; Education, Medical, Graduate/methods ; Clinical Competence
    Language English
    Publishing date 2023-07-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-023-01677-w
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  2. Article ; Online: Home practice for robotic surgery: a randomized controlled trial of a low-cost simulation model.

    Wile, Rachel K / Brian, Riley / Rodriguez, Natalie / Chern, Hueylan / Cruff, Jason / O'Sullivan, Patricia S

    Journal of robotic surgery

    2023  Volume 17, Issue 5, Page(s) 2527–2536

    Abstract: Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78( ...

    Abstract Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78(2): 379-381, 2021) described a low-cost simulation model to learn hand movements for robotic surgery. Our study evaluates whether practice with low-cost home simulation models can improve trainee performance on robotic surgery simulators. Home simulation kits were adapted from those described by Cruff (J Surg Educ 78(2): 379-381, 2021). Hand controllers were modified to mimic the master tool manipulators (MTMs) on the da Vinci Skills Simulator (dVSS). Medical students completed two da Vinci exercises: Sea Spikes 1 (SS1) and Big Dipper Needle Driving (BDND). They were subsequently assigned to either receive a home simulation kit or not. Students returned two weeks later and repeated SS1 and BDND. Overall score, economy of motion, time to completion, and penalty subtotal were collected, and analyses of covariance were performed. Semi-structured interviews assessed student perceptions of the robotic simulation experience. Thirty-three medical students entered the study. Twenty-nine completed both sessions. The difference in score improvement between the experimental and control groups was not significant. In interviews, students provided suggestions to increase fidelity and usefulness of low-cost robotic home simulation. Low-cost home simulation models did not improve student performance on dVSS after two weeks of at-home practice. Interview data highlighted areas to focus future simulation efforts. Ongoing work is necessary to develop low-cost solutions to facilitate practice for robotic surgery and foster more inclusive and accessible surgical education.
    MeSH term(s) Humans ; Robotic Surgical Procedures/methods ; Clinical Competence ; Computer Simulation ; Robotics/education ; Students, Medical ; Simulation Training
    Language English
    Publishing date 2023-08-02
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-023-01688-7
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  3. Article ; Online: Transanal excision of rectal lesions using the single port robotic platform: A video vignette.

    Romero-Hernandez, Fernanda / Wang, Jaeyun Jane / Nakamura, Yukino / Chern, Hueylan / Sarin, Ankit

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2023  Volume 25, Issue 11, Page(s) 2275–2279

    MeSH term(s) Humans ; Robotic Surgical Procedures ; Rectum/surgery ; Rectum/pathology ; Rectal Neoplasms/surgery ; Rectal Neoplasms/pathology ; Digestive System Surgical Procedures ; Transanal Endoscopic Surgery
    Language English
    Publishing date 2023-10-14
    Publishing country England
    Document type Video-Audio Media ; Letter
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16759
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  4. Article ; Online: Robotic transanal excision of rectal lesions: expert perspective and literature review.

    Watanaskul, Sarah / Schwab, Marisa E / Chern, Hueylan / Varma, Madhulika / Sarin, Ankit

    Journal of robotic surgery

    2022  Volume 17, Issue 2, Page(s) 619–627

    Abstract: Transanal excision of benign lesions, moderately or well-differentiated rectal T1 adenocarcinomas is typically completed via transanal endoscopic microsurgery (TEM) or laparoscopic transanal minimally invasive surgery (TAMIS). Robotic platforms provide ... ...

    Abstract Transanal excision of benign lesions, moderately or well-differentiated rectal T1 adenocarcinomas is typically completed via transanal endoscopic microsurgery (TEM) or laparoscopic transanal minimally invasive surgery (TAMIS). Robotic platforms provide ergonomic comfort in an enclosed space, enhanced range of motion, and superior 3D visualization. This study sought to perform a literature review of robotic TAMIS (R-TAMIS) and provide expert commentary on the technique. A Pubmed literature search was performed. Study design, robot type, indication, techniques compared, surgical margins, conversion, complications, operative time, estimated blood loss, patient positioning, and defect closure were collected from included articles. Expert opinion on pre-operative planning, technical details, and possible pitfalls was provided, with an accompanying video. Twelve articles published between 2013 and 2022 were included. Five were case reports, three case series, two prospective cohort studies, one retrospective cohort study, and one Phase II trial. The Da Vinci Si (n = 3), Xi (n = 2), single port (n = 3) and flex robotic system (n = 2) were used. Five studies reported negative surgical margins, one reported positive margins, and six did not comment. Operating room time ranged from 45 to 552 min and EBL ranged from 0 to 100 mL. Patient positioning varied based on lesion location but included supine, prone, modified lithotomy, and prone jackknife positions. 11/12 studies reported defect closure, most commonly with V-Loc absorbable suture. We recommend pre-operative MRI abdomen/pelvis, digital rectal exam, and rigid proctoscopy; prone jackknife patient positioning to avoid collisions with robotic arms; and defect closure of full-thickness excisions with backhanded running V-Loc suture.
    MeSH term(s) Humans ; Robotics ; Robotic Surgical Procedures/methods ; Retrospective Studies ; Prospective Studies ; Rectum/surgery ; Rectal Neoplasms/surgery ; Anal Canal
    Language English
    Publishing date 2022-10-16
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-022-01469-8
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  5. Article ; Online: Robotic training for medical students: feasibility of a pilot simulation curriculum.

    Greenberg, Anya L / Syed, Shareef M / Alseidi, Adnan / O'Sullivan, Patricia S / Chern, Hueylan

    Journal of robotic surgery

    2022  Volume 17, Issue 3, Page(s) 1029–1038

    Abstract: While robotic procedures are growing rapidly, medical students have a limited role in robotic surgeries. Curricula are needed to enhance engagement. We examined feasibility of augmenting Intuitive Surgical (IS) robotic training for medical students. As a ...

    Abstract While robotic procedures are growing rapidly, medical students have a limited role in robotic surgeries. Curricula are needed to enhance engagement. We examined feasibility of augmenting Intuitive Surgical (IS) robotic training for medical students. As a pilot, 18 senior students accepted an invitation to a simulation course with a daVinci robot trainer. Course teaching objectives included introducing robotic features, functionalities, and roles. A 1-h online module from the IS learning platform and a 4-h in-person session comprised the course. The in-person session included an overview of the robot by an IS trainer (1.5 h), skills practice at console (1.5 h), and a simulation exercise focused on the bedside assist role (1 h). Feasibility included assessing implementation and acceptability using a post-session survey and focus group (FG). Survey responses were compiled. FG transcripts were analyzed using inductive thematic analysis techniques. Fourteen students participated. Implementation was successful as interested students signed up and completed each of the course components. Regarding acceptability, students reported the training valuable and recommended it as preparation for robotic cases during core clerkships and sub-internships. In addition, FGs revealed 4 themes: (1) perceived expectations of students in the OR; (2) OR vs. outside-OR learning; (3) simulation of stress; and (4) opportunities to improve the simulation component. To increase preparation for the robotic OR and shift robotic training earlier in the surgical education continuum, educators should consider hands-on simulation for medical students. We demonstrate feasibility although logistics may limit scalability for large numbers of students.
    MeSH term(s) Humans ; Robotics/education ; Robotic Surgical Procedures/methods ; Students, Medical ; Feasibility Studies ; Curriculum ; Clinical Competence ; Simulation Training/methods
    Language English
    Publishing date 2022-12-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-022-01508-4
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  6. Article ; Online: Comparison of advanced techniques for local excision of rectal lesions: a case series.

    Schwab, Marisa E / Hernandez, Sophia / Watanaskul, Sarah / Chern, Hueylan / Varma, Madhulika / Sarin, Ankit

    BMC surgery

    2022  Volume 22, Issue 1, Page(s) 117

    Abstract: Background: Robotic transanal minimally invasive surgery (R-TAMIS) is an appealing alternative to transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) for benign and early malignant rectal lesions that are not ... ...

    Abstract Background: Robotic transanal minimally invasive surgery (R-TAMIS) is an appealing alternative to transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) for benign and early malignant rectal lesions that are not amenable to traditional open transanal excision. However, no studies to our knowledge have directly compared the three techniques. This study sought to compare peri-operative and pathologic outcomes of the three approaches.
    Methods: The records of 29 consecutive patients who underwent TEM, TAMIS, or R-TAMIS at a single academic center between 2016 and 2020 were reviewed. Intra-operative details, pathological diagnosis and margins, and post-operative outcomes were recorded. The three groups were compared using chi-square and Kruskal-Wallis tests.
    Results: Overall, 16/29 patients were women and the median age was 57 (interquartile range (IQR): 28-81). Thirteen patients underwent TEM, six had TAMIS, and 10 had R-TAMIS. BMI was lower in the R-TAMIS patients (24.7; IQR 23.8-28.7), than in TEM (29.3; IQR 19.9-30.2), and TAMIS (30.4; IQR 26.6-32.9) patients. High grade dysplasia and/or invasive cancer was more common in TAMIS (80%) and R-TAMIS (66.7%) patients than in TEM patients (41.7%). The three groups did not differ significantly in tumor type or distance from the anal verge. No R-TAMIS patients had a positive surgical margin compared to 23.1% in the TEM group and 16.7% in the TAMIS group. Length of stay (median 1 day for TEM and R-TAMIS patients, 0 days for TAMIS patients) and 30-day readmission rates (7.7% of TEM, 0% of TAMIS, 10% of R-TAMIS patients) also did not differ among the groups. Median operative time was 110 min for TEM, 105 min for TAMIS, and 76 min for R-TAMIS patients.
    Conclusions: R-TAMIS may have several advantages over other advanced techniques for transanal excisions. R-TAMIS tended to be faster and to more often result in negative surgical margins compared to the two other techniques.
    MeSH term(s) Anal Canal/surgery ; Female ; Humans ; Middle Aged ; Operative Time ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectum/pathology ; Rectum/surgery ; Transanal Endoscopic Surgery/methods
    Language English
    Publishing date 2022-03-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050442-1
    ISSN 1471-2482 ; 1471-2482
    ISSN (online) 1471-2482
    ISSN 1471-2482
    DOI 10.1186/s12893-022-01543-w
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  7. Article ; Online: Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape.

    Charondo, Leslie Bernal / Brian, Riley / Syed, Shareef / Chern, Hueylan / Lager, Jeannette / Alseidi, Adnan / O'Sullivan, Patricia / Bayne, David

    Surgery open science

    2023  Volume 16, Page(s) 1–7

    Abstract: Background: Opportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to ... ...

    Abstract Background: Opportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons' perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs.
    Methods: Laparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis.
    Results: Fourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development.
    Conclusions: This qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery.
    Key message: This qualitative study identified laparoscopic educators' perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.
    Language English
    Publishing date 2023-09-12
    Publishing country United States
    Document type Journal Article
    ISSN 2589-8450
    ISSN (online) 2589-8450
    DOI 10.1016/j.sopen.2023.09.006
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  8. Article ; Online: Artificial intelligence based real-time video ergonomic assessment and training improves resident ergonomics.

    Hamilton, Barbara Cs / Dairywala, Mohammed I / Highet, Alexandra / Nguyen, Tom C / O'Sullivan, Patricia / Chern, Hueylan / Soriano, Ian S

    American journal of surgery

    2023  Volume 226, Issue 5, Page(s) 741–746

    Abstract: Background: Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents.: Methods: Surgery ... ...

    Abstract Background: Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents.
    Methods: Surgery residents performed simulated laparoscopic tasks before and after a review of the SCORE ergonomics curriculum while filmed with a sensorless app from Kinetica Labs that calculates joint angles as a metric of ergonomics. A survey was completed before the session and a focus group was conducted after.
    Results: Thirteen surgical residents participated in the study. The brief intervention took little time and residents improved their ergonomic scores in neck and right shoulder angles. Residents expressed increased awareness of ergonomics based on the session content and AI information. All trainees desired more training in ergonomics.
    Conclusions: Ergonomic assessment AI software can provide immediate feedback to surgical trainees to improve ergonomics. Additional studies using sensorless AI technology are needed.
    MeSH term(s) Humans ; Artificial Intelligence ; Curriculum ; Ergonomics ; Musculoskeletal Diseases ; Software
    Language English
    Publishing date 2023-07-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.07.028
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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.42: Show issues Location:
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  9. Article ; Online: Beyond watching: Harnessing laparoscopy to increase medical students' engagement with robotic procedures.

    Barnes, Katherine E / Brian, Riley / Greenberg, Anya L / Watanaskul, Sarah / Kim, Eric K / O'Sullivan, Patricia S / Chern, Hueylan

    American journal of surgery

    2023  Volume 226, Issue 1, Page(s) 143–144

    MeSH term(s) Humans ; Students, Medical ; Robotic Surgical Procedures ; Robotics ; Laparoscopy
    Language English
    Publishing date 2023-02-25
    Publishing country United States
    Document type Editorial
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.02.024
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    Uk I Zs.42: Show issues Location:
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  10. Article ; Online: A robotic teaching session: separating tool from technique to emphasize a cognitive focused teaching environment.

    Green, Courtney A / O'Sullivan, Patricia S / Chern, Hueylan

    Journal of robotic surgery

    2019  Volume 13, Issue 6, Page(s) 735–739

    Abstract: Most robotic curriculum requires simulation on a console prior to operative exposure. This practice does not permit experiencing the physical collisions with the robotic tools, which occurs during surgery. We designed and evaluated an innovative ... ...

    Abstract Most robotic curriculum requires simulation on a console prior to operative exposure. This practice does not permit experiencing the physical collisions with the robotic tools, which occurs during surgery. We designed and evaluated an innovative curriculum to address cognitive components and trouble-shoot robotic collisions when the surgeon lacks haptic feedback. We adapted our previous curriculum, designed to teach and document proficiency of robotic docking and instrument exchange, to include robotic collisions. Participants received a 10-min, didactic presentation describing finger grips, internal and external collisions, and instruction on how to trouble-shoot each type. Residents worked in pairs, one at the console and the other at bedside, to complete two simulation exercises. Participants manipulated the robot to determine how best to resolve the situations. Residents completed retrospective post-course surveys and instructors completed a final survey. For comparison, non-participants, PGY-matched surgical trainees, also completed a survey. All participants demonstrated proficiency in docking and instrument exchange. Compared to pre-session, post-session knowledge and confidence improved in five domains reflecting session objectives (p < 0.05). Participants could list and troubleshoot collisions more than the non-participant matched peers (p < 0.05). Instructors supported the additional collision components, but noted learners needed more time. Two of three non-participants expressed interest in a teaching session to address these components. Collisions occur using robotic technology and rarely get addressed in surgical training. We describe an opportunity for surgeons to trouble-shoot robotic collisions in a safe, simulated environment. This easily transferable curriculum represents one of the first industry-independent robotic teaching sessions for surgical trainees.
    MeSH term(s) Clinical Competence/statistics & numerical data ; Humans ; Internship and Residency ; Retrospective Studies ; Robotic Surgical Procedures/education ; Surgeons/education ; Surgeons/statistics & numerical data
    Language English
    Publishing date 2019-01-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-019-00921-6
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